Transnasal insufflation - A new approach in the treatment of OSAs

Obstructive sleep apnea (OSA) syndrome leads to intermittent hypoxemia, sleep fragmentation, metabolic dysfunction, and increased cardiovascular morbidity and mortality. Current treatment options, including continuous positive airway pressure (CPAP), oral appliances, and surgical procedures, are often intrusive or invasive and not well tolerated, leaving a vast number of subjects untreated. Therefore, improved therapeutic strategies are required to treat sleep apneas and hypopneas and their associated morbidity and mortality. Currently, CPAP is most effective in eliminating apneas and hypopneas, although long-term effectiveness is compromised by low adherence, which is estimated at only 50-60% and even lower in children or patients with comorbid conditions like chronic obstructive pulmonary disease (COPD), stroke, or heart failure. An open nasal cannula system delivering warm and humidified air (Fig. 20.1) has been introduced as a method for increasing pharyngeal pressure [1]. This chapter summarizes the studies that were conducted with treatment with nasal insufflation (TNI) in adults and children with OSA and hypopnea across a spectrum of disease severity.